4. ULCERATIVE COLITIS
● PYODERMA
GANGRENOSUM
● Irregular boggy blue
red ulcer with
undermined borders
surrounding necrotic
bases
● Ulcerative
colitis,crohn’s
disease,leukemia,beh
cet’s disease
5. ● ERYTHEMA
NODOSUM
● panniculitis
● Bilateral
● Indurated, very tender
nodules not sharply
marginate
● Anterior aspect of
leg,knee,arms
● Sarcoidosis,IBD,Ulcer
ative colitis,bacterial
infection,leukemia
6. ● Pyoderma vegetans (PV)
● rare
● large verrucous plaques
with elevated borders and
multiple pustules
● Bacterial
infection,ulcerative
colitis, diffuse T-cell
lymphoma,alcoholism
with malnutrition, HIV
infection,chronic
myeloid leukemia
7. ● Pyostomatitis vegetans
(PV)
● pustules that affect the
oral mucosa
● Ulcerative colitis
● Crohn’s disease
● epithelial acanthosis and
superficial ulceration
with intraepithelial and ⁄
or subepithelial abscesses
containing large numbers
of eosinophils
9. MASTOCYTOSIS
● URTICARIA
PIGMENTOSA
● Darier sign is
“positive”
● Cutaneous infiltration
of mast cells
● In classical Darier's
sign, gentle rubbing or
stroking of the lesions,
is followed by local
itching, erythema and
weal formation within
2-5 min
10. PELLAGRA
● Photodermatitis over
neck hands and
forearm
● niacin deficiency.
● GAUNTLET OF
PELLAGRA
● CASAL NECKLACE
● 3D’s
dermatitis,dementia,dia
rrhea
13. ● PSEUDOXANTHO
MA ELASTICUM
● Autosomal recessive
● Peau d orange
● Cluster of yellow
papules in reticular
pattern.
● GI hemorrhage
,hypertension,claudic
ation.
15. GARDENER’S SYNDROME
● Gardner syndrome:
osteoma of the
mandible.
● Gastrointestinal
polyp,lipoma,epider
moid cyst.
● Mutation of APC
gene .chromosome
5q21
16. GLUCOGANOMA
● Migratory necrolytic
erythema
● α cell tumor of the
pancreas.
● Inflammatory patches
and red plaques of
gyrate, circinate,
arcuate, or annular
shape that enlarge with
central clearing,
● perioral and perigenital
regions and flexures
and intertriginal areas.
20. SKIN LESIONS IN HEPATIC
CELL FAILURE
● SPIDER ANGIOMA
● Spider angioma is a
very common red
focal telangiectatic
network of dilated
capillaries radiating
from a central
arteriole (punctum)
● Pregnancy
● Viral hepatitis
24. NEUROFIBROMATOSIS
● Neurofibromas-Skincolored,p
ink, or brown,
flat,dome-shaped or
pedunculated . soft or firm,
sometimes tender; “buttonhole
sign”—invagination with the
tip of the index finger is
pathognomonic
● Café-au-lait macules
● Light or dark brown uniform
melanin pigmentation with
sharp margination.
● Plexiform neuromas
● Drooping, soft, doughy may be
massive.
25. TUBEROUS SCLEROSIS
● Tuberous sclerosis is an
autosomal dominant
disease
● Angiofibromas
● Confluent, small,
angiomatous
(erythematous,
glistening) papules on the
cheek and nose
● They are
● firm and disseminated
but may coalesce; termed
adenoma sebaceum
26. ● Periungual fibroma
(Koenen tumor)
● Proliferation of
fibroblasts, increased
collagen
,angioneogenesis,
capillary dilatation,
absence of elastic
tissue
28. STURGE WEBER SYNDROME
● PORT WINE STAIN
● irregularly shaped,red
or violaceous,
macular capillary
malformation that is
present at birth and
never disappears
spontaneously
31. POLYCYTHEMIA
● ERYTHERMALGIA
(mitchell’s disease)
● neurovascular peripheral
pain disorder in which
blood vessels, usually in the
lower extremities (or
hands), are episodically
blocked then become
hyperemic and inflamed.
33. Chloroma
● Granulocytic sarcoma, also known as
chloroma or extramedullary
myeloblastoma, is a rare solid tumor
composed of primitive precursors of the
granulocytic series of WBC that include
myeloblasts, promyelocytes, and
myelocytes
34. Chloroma
● Chloromas usually present as
reddish-blue, not green,
thickenings in the skin, but
pressing the blood out of the
nodule (Panel B) unmasks a
green color for a few seconds
(Panel C). The green color is
attributed to the presence of
myeloperoxidase. This color is
rarely seen because the green
pigment fades readily on
exposure to the air and the red
color of the blood masks the
green pigment. Chloros is an
ancient Greek word for green
35. SWEET’S SYNDROME
• FEBRILE NEUTROPHILIC DERMATOSIS
• Robert Douglas Sweet
• Presence of leucocytes in lower dermis with
edema of papillary body.
• Red or bluish red papules or nodules.
• Main locations are the face, neck, and upper
limbs.
• MC associated with AML.mc solid tumor
causing are genito urinary.
36.
37. Leukemia cutis
● Leukemia cutis (LC) is a localized or
disseminated skin infiltration by leukemic
cells. It is usually a sign of dissemination
of systemic disease or relapse of existing
leukemia.
● Most commonly occurs with acute
monocytic leukemia M5 and acute
myelomonocytic leukemia M4
38. • Most common lesions are small (2–5 mm)
papules, nodules or plaques.
• pink, violaceous, or darker than normal
skin, always palpable, indurated, firm, or
guttate psoriasiformor lymphomatoid
papulosis-like lesions, but usually not
tender.
• Localized or disseminated; usually on
trunk usually on trunk extremities and
face but may occur at any site.
39. • Leukemic gingival infiltration
• (hypertrophy) occurs with acute monocytic
• leukemia.
• The diagnosis is made by suspicion and verified
• by skin biopsy, immunophenotyping, and B or T
• cell receptor rearrangement studies
• Thus, a combination of systemic chemotherapy
and local electron beam therapy or PUVA may be
necessary for chemotherapy- resistant LC lesions.
40.
41. Chediak higashi syndrome
● autosomal recessive
● microtubule polymerization
defect
● decrease in phagocytosis
● pyogenic infections, partial
albinism and peripheral
neuropathy. Pigment
dilution of hair
43. ● Mycosis fungoides:
leonine facies
● Histologically,
epidermotropism of T
cells with
hyperconvoluted
nuclei. In the tumor
stage dermal nodular
infiltrates.
● Categorized as patch,
plaque, or tumor stage
44. CRYOGLOBULINEMIA
● Cryoglobulinemia (CG) is the presence of
serum immunoglobulin (precipitates at
low temperature and redissolves at 37°C)
complexed with other immunoglobulins or
proteins.
45. • Precipitation of cryoglobulins causes vessel
occlusion, also associated with
hyperviscosity.
• Immune complex deposition followed by
complement activation and inflammation.
• Platelet aggregation/consumption of clotting
factors by cryoglobulins, causing coagulation
disorder.
• Small-vessel thromboses and vasculitis
produced by immune complexes
51. Acquired hypertrichosis lanuginosa
● Hypertrichosis lanuginosa
acquisita is a very rare
condition characterised by
the rapid growth of long,
fine, lanugo-type
(i.e.fetal) hair particularly
around the eyebrows,
forehead, ears and nose.
● Tumors associated are
adenocarcinoma of
gatrointestinal tract,lung
carcinomas.
52.
53. Acanthosis Nigricans
• Affected skin has a
hyperpigmented
velvety appearance and
in severe cases can
become verrucous.
• Flexural part like axilla
groin,neck
• Adenocarcinoma of
stomach
• d/d
• Diabetes mellitus
54. Sign of Leser-Trelat
• The sign of
Leser-Trelat describes
the sudden appearance
and/or rapid increase in
size of multiple
seborrheic keratoses.
• Adenocarcinoma of git
• tumors of the female
reproductive system
• lymphoproliferative
disorders
55. ● Tripe Palms
● Tripe palms refer to a wrinkled or ridged
appearance of palmar skin; the soles may
occasionally be involved as well.
● Tripe palms are characterized clinically by
thickened velvety palms with pronounced
dermatoglyphics
56.
57. Dermatomyositis
● Proximal muscle weakness, elevated CK
and aldolase
● Heliotrope rash, Gottron’s papules, and
others
◦Poikiloderma, periungual telangiectasia,
scalp pruritis and erythema
58. Heliotrope Rash in Dermatomyositis
● Heliotrope rash (violaceous erythema) of
periorbital skin
59. ● Violaceous erythema
and Gottron papules
on the dorsa of the
hands and fingers,
especially over the
metacarpophalangeal
and interphalangeal
joints
60. Gottron’s papules in Dermatomyositis
● Flat-topped, violaceous or erythematous
papules on extensor surfaces
63. Erythroderma
● Exfoliative dermatitis with a dramatic presentation
characterized by widespread erythema and scaling of
skin
● Often have lymphadenopathy, headaches, malaise,
photosensitivity, and chills
● Pathogenesis is unknown.
● Most often associated with lymphomas and leukemias
● May begin as scattered erythematous pruritic patches
that generalize with time
● Palms and soles usually spared
● Treat the underlying malignancy and use topical steroids
65. ● Sister Mary Joseph nodule is metastatic
carcinoma to umbilicus from
intraabdominal carcinoma, most
commonly stomach, colon, ovary,
pancreas; however, primary may be in
breast.
● Easier to detect by palpation than by
visual detection.
67. PANCREAS
● DIABETES MELLITUS
● Necrobiosis Lipoidica (NL)
● Female: male ratio 3:1
● well-demarcated waxy plaque of
variable size The sharply defined
and slightly elevated border
retains a brownish-red color,
whereas the center becomes
depressed and acquires a
yellow-orange hue.
● bilaterally on the pretibial or
medial malleolar areas
● Not painful
● Diabetic control has no effect on
the course of NL.
68. PANCREAS
● DIABETES MELLITUS
● Granuloma Annulare
(GA)
● Firm, smooth, shiny,
beaded,dermal papules
and plaques, 1–5 cm
annular,arciform plaques
with central depression
skin-colored, violaceous,
erythematous on the
dorsa of the hands and
feet, elbows, and knees.
69. PANCREAS
● DIABETES MELLITUS
● Diabetic Bullae
● Histologically, bullae
show intra- or
subepidermal clefting
without acantholysis.
● Large, intact bullae arise
spontaneously on the
lower legs, feet, dorsa of
the hands, and fingers on
noninflamed bases
72. Hyperthyroidism and the Skin
● Thyroid hormone plays a pivotal role in
the growth and formation of hair and
sebum production.
● Thyroid hormone stimulates epidermal
oxygen consumption, protein synthesis,
mitosis, and determination of epidermal
thickness.
● There is increased cutaneous blood flow
and peripheral vasodilation.
73. Hyperthyroidism and the Skin
● Skin is usually warm, moist, and smooth
● Facial flushing
● Palmar erythema
● Hyperpigmentation, esp. creases of palms and soles,
gingiva, and buccal mucosa
● Hyperhydrosis, particularly of palms and soles
● Scalp hair can be soft, fine and sometimes accompanied
by non-scarring alopecia
● 5% of patients with hyperthyroidism have nail findings
(14)
74. Plummer’s Nail in Hyperthyroidism
“Plummer’s nail”: concave contour and distal onycholysis, esp.
the ring finger (not specific- also seen in hypothyroidism,
psoriasis, after trauma, or in allergic contact dermatitis)
76. Thyroid acropachy (1% of Graves’ patients)
Triad of digital clubbing, soft tissue swelling of hands and feet, and
periosteal new bone formation
77. Hypothyroidism Facies with
Generalized Myxedema
● Generalized myxedema
◦ Occurs as a result of
deposition of dermal acid
mucopolysaccharides (esp.
hyaluronic acid and
chondroitin sulfate) in the
skin
◦ Skin is non-pitting
◦ Face: swollen lips, broad
nose, macroglossia, and
puffy eyelids
78. Alopecia Areata Associated with
Autoimmune Thyroid Disease
◦ Rapid onset of total
hair loss in a sharply
defined, usually round,
area
◦ Regrowth begins in 1
to 3 months and may
be followed by loss in
the same or other areas
79. Pemphigus foliaceus Associated with
Autoimmune Thyroid Disease
● Pemphigus foliaceus:
recurrent shallow
erosions, erythema,
scaling, and crusting
80. Pemphigus vulgaris Associated with
Autoimmune Thyroid Disease
▪Nonpruritic flaccid blisters varying in size from 1 to several cm appear
gradually on normal or erythematous skin
▪Invariably generalize if left untreated
81. ● THE SKIN IN IMMUNE,
AUTOIMMUNE, AND RHEUMATIC
DISORDERS
82. lupus erythematosus
● The most frequent cutaneous
manifestation of SLE are malar
rash(58%),photosensitivity(45%),discoid
rash (10%),livedo reticularis(14%)
83. ● Acute cutaneous LE (ACLE) is practically always
associated with SLE, subacute cutaneous LE
(SCLE) in about 50%, and chronic cutaneous LE
(CCLE) most often has only skin disease.
● LE occurs more commonly in women (male to
female ratio 1: 9).
● LE ranges from life-threatening manifestations of
● acute systemic LE (SLE) to the limited and
exclusive
● skin involvement in chronic cutaneous LE
● (CCLE)
84. Abbreviated Gilliam Classification
of Skin Lesions of LE
LE-specific skin disease [cutaneous LE* (CLE)]
A. Acute cutaneous LE [ACLE]
1. Localized ACLE (malar rash; butterfly rash)
2. Generalized ACLE (maculopapular lupus rash,
malar rash, photosensitive lupus dermatitis)
B. Subacute cutaneous LE [SCLE]
1. Annular SCLE
2. Papulosquamous SCLE (disseminated DLE,
subacute disseminated LE, maculopapular
photosensitive LE)
∗
85. C. Chronic cutaneous LE [CCLE]
1. Classic discoid LE [DLE]: (a) localized DLE; (b)
generalized DLE
2. Hypertrophic/verrucous DLE
3. Lupus profundus
4. Mucosal DLE: (a) oral DLE; (b) conjunctival DLE
5. Lupus tumidus (urticarial plaque of LE)
6. Chilblains LE (chilblains lupus)
7. Lichenoid DLE (LE/lichen planus overlap)
II. LE-nonspecific skin disease
.
86. ● Bright red, sharply
defined erythema
with slight edema
and minimal scaling
in a “butterfly
pattern” on the face.
87. Systemic lupus
erythematosus
● Systemic lupus
erythematosus: nail fold
erythema and
telangiectasis
● Proximal nail folds are
enlarged with erythema,
telangiectasis,and
thromboses. The cuticle
is elongated.
90. ● Chronic cutaneous
lupus erythematosus
Well-demarcated,
erythematous,
hyperkeratotic plaques
with atrophy, follicular
plugging, and adherent
scale on both cheeks.
This is the classic
presentation of chronic
discoid LE.
91. BEHÇET DISEASE
● The lesions are the result of
leukocytoclastic (acute) and lymphocytic
(late) vasculitis.
92.
93.
94. LIVEDO RETICULARIS
● Livedo reticularis (LR) is a
mottled bluish (livid)
discoloration of the skin that
occurs in a netlike pattern.
● ILR pattern due to
vasospasm or obstruction of
perpendicular arterioles,
perforating dermis from
below. Cyanotic periphery
of each web of net caused
by deoxygenated blood in
surrounding horizontally
arranged venous plexuses.
95. ● Idiopathic livedo reticularis (ILR)
● secondary livedo reticularis:
● Vasculitis autoimmune conditions:
● Livedoid vasculitis - with painful
ulceration occurring in the lower legs
● Polyarteritis nodosa
● Systemic lupus erythematosus[7]
● Dermatomyositis
● Rheumatoid arthritis
● Lymphoma
● Pancreatitis[8]
● Tuberculosis
● Amantadine (drug)
● Obstruction of capillaries:
● Cryoglobulinaemia Antiphospholipid
syndrome
● Hypercalcaemia
● Polycythaemia rubra vera or
Thrombocytosis
● Infections (syphilis,tuberculosis, lyme
disease)
97. Wegener granulomatosis
● Wegener
granulomatosis
● A pyoderma
gangrenosum-like
irregular ulceration on
the cheek with jagged
and undermined
borders is often the
first manifestation of
Wegener
gramulomatosis.
99. ● Wegener
granulomatosis
● A large ulcer on the
palatecovered by a
dense, adherent,
necrotic mass; note
accompanying edema
of the upper lip.
Similar lesions occur
in the sinuses and
tracheobronchial tree.
100. Reactive arthritis(reiter’s syndrome)
● keratoderma
blennorrhagicum-
Red-to-brown
papules, vesicles, and
pustules with central
erosion and
characteristic
crusting and
peripheral scaling on
the dorsolateral and
plantar foot.
108. • Dermatopathology -Incisional, deep
biopsy shows calcification of the media of
small and medium-sized blood vessels in
the dermis and subcutaneous tissue.
Intraluminal fibrin thrombi are present.
109. NEPHROGENIC FIBROSING
DERMOPATHY (NFD)
● NFD is a fibrosing disorder in patients
with acute or chronic renal failure.
● Most patients receiving hemodialysis,
peritoneal dialysis; in acute renal failure
NFD occurs without dialysis.
110. ● NFD is characterized by acute onset,
brawny indurations, plaquelike or nodular,
bound down upon palpation ,up to 20 cm
and more in diameter, with an uneven
rippled surface
111. A brawny platelike induration bound down
upon
palpation, with an uneven surface on the legs.
114. EXANTHEMATOUS DRUG
REACTIONS
● Most common; initial reactions reaction
usually <14 days after drug intake; recurs
after rechallenge
● Cutaneous eruption that mimics a
measles-like viral exanthem.
● Systemic involvement is low.
● Synonyms : Morbilliform drug reaction,
maculopapular drug reaction.
115. ● Drugs with a high probability of reaction-
penicillin and related antibiotics,
carbamazepine, allopurinol, gold salts .
● Medium probability : sulfonamides
nonsteroidal anti-inflammatory drugs,
hydantoin derivatives, isoniazid.
● Low probability : barbiturates,
benzodiazepines, phenothiazines,
tetracyclines
116.
117. PUSTULAR ERUPTIONS
● Acute generalized
exanthematous pustulosis
(AGEP) is an acute
febrile eruption that is
often associated with
leukocytosis .
